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Wednesday, August 17, 2011

Fear, death, and being human: thoughts before surgery

Heart and blood vessels
(Leonardo da Vinci)

I am scheduled to have open-heart surgery next week.

They will open my chest, slicing right down the sternum, and they'll hook me up to a machine to pump my blood and keep me oxygenated while they mend my innards. I am told this will take from three to six hours.

Fortunately, I will be sound asleep the whole time. And to prevent any operating-room chatter from possibly invading my dormant brain cells, large noise-cancelling headphones will fill my ears with reassuring music.

I've known this was coming since 2003. In May 2008 I wrote a brief note about it here. Last March my cardiologist and I agreed that it's time to go ahead. A defective valve needs replacing. An aneurysm needs repairing. Some faulty electrical circuits need rewiring. Bring on the plumbers and electricians.

As Samuel Johnson said to his friend Boswell, "Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully."

In my case, the mental concentration is another word for fear. I felt fear when my cardiologist announced, "Mrs. Neff, you are not normal." (I also burst out laughing, which puzzled him.) I've felt fear every time I've had echocardiograms, CT scans, MRIs, Holter monitor readings, and other tests - and I've had a lot of them. When the doctors decided I needed a catheter ablation, I could not stop shaking. My thoughts turned dark and morbid during three days in the hospital while they started me on a potent medication.

Most of the time, thank goodness, I can deal with fear. Denial works remarkably well. Failing that, joking can be effective. But when surgery became a date on my calendar, not just a remote possibility, I knew I had to pay attention. So I asked myself the obvious question, What are you afraid of? And I gave myself the obvious answers: Pain. Serious side-effects of surgery, such as stroke. Undesirable brain changes, such as compulsive alliteration.

Death.

Not much chance of that, they tell me. The numbers are excellent: the survival rate is at least 97 percent. I'm otherwise healthy, and my surgeon is one of the best. Not much chance of stroke, either. It happens, but not to the vast majority of patients.

When I strode up to the Grim Reaper to fling these statistics in his face, he was not impressed. Life, he pointed out, is a sexually transmitted condition that is 100 percent fatal. At age 63, if I am average, I can expect to live another 26 years (check out your own life expectancy here). That no longer seems very long. What's more, my healthy life expectancy is only another 8 years, according to the World Health Organization's database. I'm guessing I might have more time than that because I've never smoked, have had excellent medical care, have eaten good food, have exercised. My parents did all of those things too, and their health was good up to about age 79. But that's still only 16 years away.

If I survive this surgery - and I believe I will - I will probably have another 10 to 20 years before the artificial valve has to be replaced, or Alzheimer's infiltrates my brain, or I am attacked by cancer or strokes or some other disease. It's going to happen because I am dust, and to dust I shall return.

This is where I might go theological, or at least pietistic, and start talking about heaven, resurrection, immortality. I'm not going to do that. Undeniably many people find comfort in their faith. Morris West, author of The Shoes of the Fisherman and many other novels, faced open-heart surgery with strong faith: "Alive or dead, I was resting in the hand of Omnipotence. I knew with absolute conviction that I could not fall out of it" (A View from the Ridge, p. 145). Before he reached that conclusion, though, he had to face his own mortality. When he went into surgery, he knew he might never wake up.

As it turned out, West lived another 11 years: he died at his desk at age 83 while working on his 28th novel. He did, however, eventually die. So did all my ancestors. So did several of my friends. So will you. So will I.

This can be hard for us Americans to accept. When doctors want to talk with us about our end-of-life plans, some of us worry about death panels. When someone dies, we want to know who's to blame (the doctor? the hospital? the deceased's habits? ourselves, for not intervening in some way?). The idea that death is a normal part of being human - from the Latin humus, earth, soil, dust - is hard for us to understand - and what we do not understand, we fear.

Voldemort, remember, means "flight of death." His followers were Death Eaters - people who feared death so much that they were willing to kill to avoid it. By contrast, Dumbledore and Harry Potter accepted death willingly, and thereby saved the wizarding world. I don't expect to save any worlds, but I am guessing that if I can accept - really accept, believe at a gut level - that I am dust, I will save myself a lot of unnecessary anxiety over the next few days.

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Oh, by the way, I may not be posting much for a while. Or - who knows - I may feel the urge to comment on every passing headline (someone please stop me! No one should blog while medicated!). If you want to keep up with Lively Dust but you don't want to keep checking back unnecessarily, sign up to "Follow by Email" - right-hand column, second box from the top.

Any surgery gives one an opportunity to make a "last" effort as a human to make a statement. Years ago, as I prepared for Lasik surgery and the (low) risk of losing my eyesight permanently, I read much haiku poetry on Twitter and then reread my favorite poems by Frost, lastly "The Road Not Taken." Happily, my eye surgery was a success and I followed up by first checking my email, a very unpoetic thing to read. Have fun planning your "last" act as a living, breathing soul with an opportunity to make a difference!